Provider Demographics
NPI:1467507566
Name:CENTER FOR DERMATOLOGY P.A.
Entity Type:Organization
Organization Name:CENTER FOR DERMATOLOGY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRATHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-677-1273
Mailing Address - Street 1:230 BEISER BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7793
Mailing Address - Country:US
Mailing Address - Phone:302-677-1273
Mailing Address - Fax:302-677-1278
Practice Address - Street 1:230 BEISER BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7793
Practice Address - Country:US
Practice Address - Phone:302-677-1273
Practice Address - Fax:302-677-1278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10006521207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000037231Medicaid
DEH65347Medicare UPIN
DE1000037231Medicaid